Pain characteristics change in patients with Duchenne muscular dystrophy (DMD) depending on the disease progression and clinical stages, according to an article published in BMC Musculoskeletal Disorders.

The pain location, aggravating and relieving factors, frequency, and interference all changed for patients with DMD depending on whether they were still ambulatory, early nonambulatory, or late nonambulatory.

Pain was reported during the previous 4 weeks in 66 out of the 148 (45%) patients with DMD included in the study. No significant difference in the prevalence was observed between groups with 38.7% of ambulatory patients, 48.6% of early nonambulatory patients, and 40% of late nonambulatory patients reporting pain. The presence of scoliosis and joint contractures did not appear to affect the prevalence.


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Pain frequency was most commonly reported as “several times per week” for ambulatory and early nonambulatory patients while late nonambulatory patients reported pain “daily.” No difference in pain intensity and or duration were observed between groups over half of patients reporting the pain duration lasting less than 1 hour. The late nonambulatory group reported pain in more areas of the body than the ambulatory and early nonambulatory groups, however (P =.042).

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Calf pain was the most frequently reported pain site for ambulatory group patients while knee pain was most frequent in early nonambulatory group patients. The late nonambulatory group reported pain most commonly in the lumbosacral spine but also reported higher levels of pain in the buttocks and chest abdomen than the ambulatory and early nonambulatory groups.

The pain appeared to interfere with the patient’s mood more in the late nonambulatory group than in the other 2 groups (P =.046).

“In patients with DMD, pain is a common symptom at all clinical stages. In particular, it is important to assess the pain of the patients in the [late nonambulatory] stage, since a higher frequency of pain, pain in more parts of the body, and more interference on mood by pain were noted in this group than in the other groups,” the authors said.

For patients in the ambulatory, early nonambulatory, and late nonambulatory groups, the most common pain aggravating factors were “ambulation,” “transfer activity,” and “sitting,” respectively. The relieving factors for ambulatory patients included “resting” and “massage” while “positional change” was most helpful in relieving pain for early nonambulatory and late nonambulatory patients.

“The results of this study suggest an interventional strategy that matches the characteristics of each stage since the pain location and aggravating/relieving factors differed according to the stage of the disease,” the authors concluded.

Reference

Kim A, Park M, Shin HI. Pain characteristics among individuals with Duchenne muscular dystrophy according to their clinical stage. BMC Musculoskelet Disord. 2022;23(1):536. doi:10.1186/s12891-022-05504-5